scholarly journals Leukocytosis interference in clinical chemistry: shall we still interpret test results without hematological data?

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Guillaume Grzych ◽  
Estelle Roland ◽  
David Beauvais ◽  
Patrice Maboudou ◽  
Giuseppe Lippi

SummaryBackgroundExtreme leukocytosis is known to induce remarkable variations of some clinical chemistry tests, thus leading to possible clinical misinterpretation. This study aimed to define whether also moderate leukocytosis may influence the stability of glucose and blood gases.MethodsBlood samples are sent to the local laboratory through a pneumatic tube system. Clinical chemistry testing is routinely performed using lithium-heparin tubes (for glucose) and heparin blood gases syringes (for blood gas analysis). Stability of glucose (in uncentrifuged blood tubes) and blood gases (in syringes) was hence evaluated in samples maintained at room temperature. Results were also analyzed in 2 subgroups of samples with different leukocyte counts, i.e., those with leukocytes <15 × 109/L and those with leukocytes >15 × 109/L.ResultsAn accelerated decrease of pH was observed in blood gases syringes with leukocytosis (i.e., >15 × 109/L), while no difference was noted for other blood gases parameters (PCO2, PO2). Spurious and time-dependent hypoglycemia was noted in uncentrifuged blood tubes of patients with leukocytosis.ConclusionsThe results of our study suggest that even modest leukocytosis (i.e., around 15 × 109/L), which is frequently encountered in clinical and laboratory practice, may be associated with significant variations of both glucose and pH. This would lead us to conclude that results of these parameters shall be accompanied by those of hematologic testing to prevent clinical misinterpretation, namely with leukocyte counts.

1994 ◽  
Vol 40 (1) ◽  
pp. 124-129 ◽  
Author(s):  
R J Wong ◽  
J J Mahoney ◽  
J A Harvey ◽  
A L Van Kessel

Abstract We evaluated a new portable instrument, the PPG StatPal II pH and Blood Gas Analysis System, designed for "point-of-care" measurements of blood gases and pH. Inaccuracy (% of target value) and imprecision (CV%) were assessed by blood tonometry and comparison with a Corning 178. Within-day results for PCO2 inaccuracy and imprecision ranged from 98.2% to 102.9% and 3.3% to 3.9%, respectively; for PO2, these were 95.5% to 102.3% and 2.3% to 3.0%, respectively. Between-day results for PCO2 inaccuracy and imprecision ranged from 99.2% to 99.3% and from 2.9% to 3.2%, respectively; for PO2, the ranges were 96.2% to 98.2% and 2.6% to 3.0%, respectively. Two PCO2 outliers (in 645 samples = 0.3%) were observed. In general, tonometry recovery, measurement stability, and pH bias results for the StatPal II and Corning 178 were comparable. We conclude that the StatPal II performs within acceptable ranges of inaccuracy and imprecision.


Author(s):  
Capan Konca ◽  
Mehmet Tekin ◽  
Fatih Uckardes ◽  
Samet Benli ◽  
Ahmet Kucuk

AbstractIn the follow-up of ventilation, invasive blood gas analysis and noninvasive monitoring of end-tidal carbon dioxide (ETCO2) are used. We aimed to investigate the relationship between capillary partial pressure of carbon dioxide (PcCO2) levels and ETCO2 and also to investigate ETCO2's predictive feature of PcCO2 levels. This study included 28 female and 30 male pediatric patients; 28 patients were type-1 respiratory failure (RF), 16 patients were acute respiratory distress syndrome, and 14 patients were type-2 RF. Our results showed a significant correlation between ETCO2 and PcCO2. Although the strength of the correlation was weak throughout the measurements, the strength of this correlation increased significantly in type-2 RF.


2009 ◽  
Vol 28 (2) ◽  
pp. 125-128 ◽  
Author(s):  
Mary Farmand

UNDERSTANDING BLOOD GAS values and acid-base balance are fundamental skills of neonatal nursing. This is because, in the NICU, blood gases are probably ordered more than any other laboratory test. The bedside nurse not only obtains the specimen, but is also crucially involved in interpreting the results because blood gases cannot stand alone; they need to be evaluated in the context of the entire clinical picture. This article provides basic information on the components of a blood gas, acid-base balance, as well as a systematic approach to blood gas analysis.


2006 ◽  
Vol 22 (5) ◽  
pp. 203-209 ◽  
Author(s):  
Junko Kato ◽  
Tomotaro Dote ◽  
Hiroyasu Shimizu ◽  
Yukari Shimbo ◽  
Michiko Fujihara ◽  
...  

Hypoglycemia is suspected in the acute lethal toxicity induced by cutaneous exposure to monochloroacetic acid (MCA). Although it has been shown that hepato-renal dysfunction is involved, the mechanism and the target organs that directly affect mortality remain to be determined. We suspected respiratory failure as a main cause of death in some reported cases. We investigated dose-response effects, hypoglycemia, and lung injury in rats exposed to MCA. Serum glucose, blood gases, and parameters of alveolar injury in bronchoalveolar lavage fluid (BALF) were analysed 2 and 4 h after subcutaneous administration of MCA (108, 135 or 163 mg/kg). Apparent pulmonary injury and hypoglycemia were not identified 2 h after administration, but lactate dehydrogenase (LDH) and total cells in BALF were dose-dependently increased; and severe hypoglycemia was identified 4 h after administration. Blood gas analysis showed remarkable alveolar gas dysfunction as exchange in the 163 mg/kg group. Thus, hypoglycemia and lung injury appear to cause death in response to MCA exposure.


2019 ◽  
Vol 47 ◽  
Author(s):  
Mariana Andrade Mousquer ◽  
Vitória Müller ◽  
Fernanda Maria Pazinato ◽  
Bruna Dos Santos Suñe Moraes ◽  
Leandro Américo Rafael ◽  
...  

Background: Wry nose is a congenital deformity that causes respiratory obstruction and decreased oxygenation rate. Gestation in a wry nose mare may be considered a risk to the neonate since it depends on the maternal environment for development. Compromised oxygenation during pregnancy can lead to fetal distress and cause consequences on fetal development. However, depending on the degree of the impairment, the fetus may still be able to adapt. The aim of the present study was to report the gestation in a mare with facial deviation until term and to assess blood gases in the mare and neonate, and to evaluate the histomorphometry of the placenta.Case: A Criollo breed mare presenting facial deviation (Wry Nose) was donated to Equine Medicine Research Group (ClinEq) of the Federal University of Pelotas (UFPel) due to the presence of the physical deformity. When the mare was five years old, it was inseminated and had a pregnancy confirmed. At the fifth month of gestation, evaluation of fetal aorta diameter, fetal orbital diameter and combined thickness of the uterus and placenta (CTUP) started to be performed monthly to assess gestation health. The assessment of the fetal orbit and aorta diameter revealed a linear increase of both variables with the progress of gestation indicating a normal fetal development.  CTUP remained in the normal reference range, presenting no alterations during the gestational length. The mare foaled at 324 days of gestation a coat showing no congenital deformities. The foaling was monitored until the complete passage of fetal membranes. A complete clinical and hematological evaluation of the foal was carried out after birth. The foal showed normal adaptive behavior, clinical and hematological parameters during the first hours of life, although presenting physical signs of immaturity. Venous blood samples were collected from the mare at 315 days of gestation, immediately after foaling and 24 h post-partum for lactate and blood gas analysis.  Mild changes were observed in the mare’s blood gas analysis at foaling that were compensated within 24 h post-partum. Venous blood samples were collected from the umbilical cord and from the foal after birth, at 12 and 24 h post-partum to measure blood gases and lactate. The newborn foal presented respiratory acidosis immediately after birth, which was metabolically compensated at 24 h post-partum. Both mare’s and foal’s lactate evaluation were within the normal reference ranges. After expulsion of the placenta, samples from the gravid horn, uterine body and non-gravid horn were collected for histological and histomorphometric evaluation. In the histological evaluation, avillous areas were detected in the gravid horn and uterine body and mild hypoplasia was found in the uterine body. Placental histomorphometry revealed larger total microcotiledonary and capillary areas on the non-gravid horn when compared to the remaining areas of the placenta (gravid horn and uterine body). No abnormalities on the placental vasculature were detected.  Discussion: To date, there are no reports of a pregnancy in a mare with facial deviation in the literature. This report showed that the wry nose mare gave birth to a viable foal showing no congenital abnormalities, which suggests that wry nose animals can be bred normally. The mare presented a healthy pregnancy, with mild changes in the blood gas analysis at foaling that were compensated at 24 h postpartum. Similarly, despite the foal showed physical signs of immaturity and respiratory acidosis at birth, these changes were compensated in the later assessments. Furthermore, no abnormalities on the placental vasculature were detected.


1994 ◽  
Vol 76 (1) ◽  
pp. 120-126 ◽  
Author(s):  
C. Prefaut ◽  
F. Anselme ◽  
C. Caillaud ◽  
J. Masse-Biron

To determine whether exercise induces hypoxemia in highly trained older “master” athletes (MA), as it does in certain elite endurance-trained young athletes (YA), 10 MA (65.3 +/- 2.6 yr), 10 control subjects (CS; 68.3 +/- 2.2 yr), and 10 endurance-trained YA (23.3 +/- 1.1 yr) performed an incremental exercise test. During testing, blood samples for arterial blood gas analysis were drawn during the last 20 s of each load. Lung exchanges were measured using a breath-by-breath automated exercise device. Exercise-induced hypoxemia (EIH) appeared in all MA and 8 of 10 YA, whereas there were no changes in the blood gases of CS. In MA, arterial PO2 decreased significantly from 40% of maximal O2 uptake onward and was associated with a significant increase in the ideal alveolar-arterial O2 difference from 60% onward. The MA also showed a lower ventilation for a given absolute load compared with CS. In all subjects arterial PCO2 rose slightly but significantly during the work, but this increase was most marked in MA. The EIH differed between MA and YA in the following ways: 1) all MA showed a drop in arterial PO2 during exercise, 2) this drop appeared earlier and was significantly greater for a given load in MA, and 3) EIH appeared at a lower level of training regimen in MA. This hypoxemia was at first isolated, probably at least partially due to relative hypoventilation, and then was associated with a widened ideal alveolar-arterial O2 difference, which may have been due to an increase in extravascular lung water.(ABSTRACT TRUNCATED AT 250 WORDS)


2018 ◽  
Vol 164 (5) ◽  
pp. 335-337 ◽  
Author(s):  
Christopher T Lewis ◽  
W L Malein ◽  
I Chesner ◽  
S Clarke

IntroductionMeasurement of physiological parameters in extreme environments is essential to advancing knowledge, prophylaxis and treatment of altitude sickness. Point-of-care testing facilitates investigation in non-specialist and remote settings, as well as becoming increasingly popular at the bedside for real-time results in the clinical environment. Arterialised capillary earlobe blood gases are recommended as a valid alternative to arterial sampling in research. This study aimed to test the feasibility of obtaining and analysing daily earlobe samples at high altitude.MethodsFrom 17 to 24 January 2016, 24 participants on a research expedition to Ecuador underwent daily earlobe blood gas measurements including pH, partial pressure of oxygen and partial pressure of carbon dioxide to 5043 m. Samples were analysed using an Abbott i-STAT blood gas analyser and G3+ cartridges.ResultsDaily measurements were successfully obtained and analysed at the point of care in 23/24 participants and were well tolerated with no adverse events. 12% (27/220) cartridges failed and required repeat sampling.ConclusionsDaily earlobe blood gas analysis using the Abbott i-STAT is feasible in a protected environment at high altitude. Participants and equipment should be kept warm before and during testing. Spare cartridges should be available. This methodology may be useful for both research and therapeutic measurements in remote, rural and wilderness medicine.


2019 ◽  
Vol 6 (4) ◽  
pp. 1016
Author(s):  
Sabiha Naz ◽  
Kiran Chugh ◽  
Isha Malik

Background: It is clearly mentioned in the medicine books that blood gas analysis from arterial puncture is the gold standard. But in the past few years it is commonly seen that clinicians have started trusting on venous blood gas analysis as well as started advising VBG (Venous blood gas) in the initial diagnosis of critical patients in emergency setting. Keeping this fact in mind, we designed a study to determine whether VBG could be a better replacement of ABG (Arterial blood gases) in the emergency where diverse pathological conditions are encountered.Methods: This prospective cross-sectional study comprised of 50 patients of 20-60 yrs age with a variety of diagnoses admitted in the emergency department. 50 paired samples (ABG+VBG) were obtained from them under strict aseptic precautions after obtaining their verbal consent. With a minimum delay of less than 2 min blood gas analysis was performed on blood gas analyzer. Parameters (pH, PCO2, PO2, HCO3, Base Excess and O2 saturation) from ABG and VBG were recorded and compared using Student’s Unpaired ‘t’ test.Results: pH and HCO3 showed statistical significant (p value <0.05) differences between ABG and VBG, while BE showed statistical non-significant (p value >0.05) difference between them. Contrary to this, PCO2, PO2 and O2 saturation from ABG and VBG showed statistical highly significant (p value <0.0001) differences.Conclusions: VBG should not be interchangeably considered in place of ABG with regard to pH, HCO3, PCO2, PO2 and O2 saturation in conditions where actual oxygenation status of patient is required (e.g.; hypovolemic shock, respiratory disorders, mechanically ventilated patients, etc.)


2020 ◽  
Vol 7 (2) ◽  
Author(s):  
Faheem Shakur ◽  
Suzanne Mason

OBJECTIVES: Many patients with respiratory complaints who present to the Accident & Emergency (A & E) department have an arterial blood gas analysis performed at some point. It is our belief that there is no difference between arterial and capillary blood gas values in patients presenting to the A & E department. It is also anticipated that body temperature and blood pressure may play a part, so these will also be reported and associations will be investigated. METHODS: Patients who require arterial blood gas analysis at any stage during their stay in the A & E department at the Northern General hospital of Sheffield are eligible for inclusion in the study. In total there were 32 patients. PROCEDURE:Transvasin cream was applied to the ear lobe to improve local blood flow by dilating the capillaries. When ten minutes have elapsed after the application of the Transvasin cream, a capillary sample is taken from the ear lobe by the researchers. CONCLUSION: From the t-tests conducted, no significant difference was seen between the arterial and capillary blood gas samples for the parameters pO2 and O2 saturation. However, for pCO2, pH and [HCO3] there were significant differences observed. This result seems to disagree with the findings of most other studies that have so far shown stronger correlations generally for pH, pCO2 and bicarbonate, than for oxygen measuring parameters.


2021 ◽  
Vol 10 (7) ◽  
pp. 1516
Author(s):  
Łukasz Gutowski ◽  
Kaja Gutowska ◽  
Alicja Brożek ◽  
Marcin Nowicki ◽  
Dorota Formanowicz

The ability to diagnose acid-base imbalances correctly is essential for physicians and other healthcare workers. Despite its importance, it is often considered too complex and confusing. Although most people dealing with arterial blood gases (ABGs) do not usually have problems with acid-base disorder assessment, such an analysis is also carried out by other healthcare workers for whom this can be a challenging task. Many aspects may be problematic, partly due to multiple data analysis methods and no definitive statement on which one is better. According to our survey, the correctness of arterial blood gas analysis is unsatisfactory, especially in mixed disorders, which do not always manifest an obvious set of symptoms. Therefore, ABG parameters can be used as an established biomarker panel, which is considered to be a powerful tool for personalized medicine. Moreover, using different approaches to analyze acid-base disorders can lead to varying diagnoses in some cases. Because of these problems, we developed a mobile application that can spot diagnostic differences by taking into account physiological and chemical approaches, including their variants, with a corrected anion gap. The proposed application is characterized by a high percentage of correct analyses and can be an essential aid for diagnosing acid-base disturbances.


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